UCDHS Academic Information Systems. Peter Yellowlees, M.B.B.S, M.D.

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1 Telepsychiatry in California Peter Yellowlees, M.B.B.S, M.D.

2 Overview Definitions and history Current status E-Mental Health Project Online training programs Future directions Mobility and store and forward telepsychiatry

3 Definitions A partial solution to the lack of specialty expertise in rural communities Traditionally, two major types of telemedicine: Synchronous - Live, two-way way interactive videoconfer- encing or telephony to facilitate a "real-time" consultation between a specialist and a primary care provider and patient, who are located in different areas. Asynchronous or store-and-forward - Transmission of clinical information via or web applications for review by a specialist.

4 Status of Telepsychiatry UC Davis - 1,000 consults per year, mainly new patients with consultation-liaison model to primary care and Indian Health Fresno Private Practice 3,000 plus consults per year, continuing care and med management, mainly to counties mental health services and primary care clinics CA Correctional system 3,000 plus consults per year from Sacramento offices around state Others Northern and Southern California

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6 Community Healthcare Center, Crescent City Pelican Bay State Prison, Crescent City Del Norte Community Health Ctr., Crescent City Mercy Medical Center, Mount Shasta Hill Country Community Clinic, Shasta Mercy Redding Hospital Humboldt Open Door Clinic Willow Creek Clinic, Willow Creek Eureka Pediatrics Berry Creek Health Center Oroville Community Hospital Biggs Griddley Memorial Hosp Camptonville Wellness Clinic Peach Tree Clinic, Marysville Colusa Community Hospital Round Valley Indian Health Center, Covelo UC Davis, Roseville Sac Family Med Clinic, Sacramento High Desert State Prison, Susanville Healdsburg General Hospital UC Davis, Davis UC Davis, J Street Sac. County Jail UC Davis, Folsom CA State Prison, Folsom Valley Mt. Regional Center, Stockton Hughson Medical Office, Hughson Stanislaus County Comm. Health Clinic, Hughson Livingston Medical Group West Hills Medical Group, Coalinga Family Healthcare Network, Porterville Wasco Medical Center, Wasco Substance Abuse Treatment Facility, Corcoran Tulare County Health Services Shafter Community Health Center UC Davis Telemedicine Network Modoc Medical Center, Alturas Eureka Community Health Center UCDHS Academic Information Systems Surprise Valley Community Hospital, Modoc Big Valley Med Center, Lassen Mayers Memorial Hospital, Fall River Mills Shasta Community Health Center Burney Skilled Nursing Facility Northeastern Rural Health Clinics, Lassen Lassen Community Hospital, Susanville Sierra Valley District Hospital, Loyalton E. Plumas District Hospital, Protola Greenville Rancheria, Quincy Plumas Health Services, Plumas Sierra Care Miner s Clinic, Nevada City St. Elizabeth Medical Center, Red Bluff Plumas District Hospital, Quincy Hamilton City Primary Care Clinic Western Sierra Medical Clinic, Downieville Fremont/Rideout Medical Center, Yuba City / Marysville Sierra Family Medical Clinic, Nevada City UC Davis, Auburn Mammoth Lakes Clinic UC Davis, Meadow Vista UC Davis, Carmichael Primary Care Clinic, Sonora Tuolumne General Hospital Sonora Mercy Medical Center, Merced Motherlode Madera Family Medical Group Hillman Health Care Center Tulare Delano Regional MC Mojave Rural Health Clinic Central CA Women s Facility, Chowchilla Desert Hot Springs Clinic Desert Hot Springs Community Health Center CDC Ironwood State Prison, Blythe Valley Family Care Center

7 E-Mental Health: Consultation-Liaison Model Using Telemedicine Traditional telepsychiatry treatment is validated from diagnostic and cost perspectives We studied real time videoconf, and provider telephony and store and forward consultations, and provided education sessions Outcomes measured in adults and children Grant funded by CTEC to supplement Medicare payments, and for the research component

8 1. Phone Consult Reply within 24 hours 2. Online Consult Reply within 24 hours Triage service to advise, see, or refer to MD 3. Videoconference psychiatry and psychology All services to 10 primary care clinics Document care via RelayHealth and/or UCD EMR

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10 Managing Mental Health Disorders in Primary Care Date & Time: July - September 2004 Location: All 10 Rural Sites Site Visits in person Presenters: Jonathan Neufeld, PhD PtrYll Peter Yellowlees, l MD Donald Hilty, MD James Bourgeois, OD, MD This presentation addressed practical issues related to managing common mental health disorders in a rural primary care setting. It covered screening, detection, diagnosis, and treatment, as well as recommended methods for integrating a remote mental health specialist consultation service into the process.

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12 Future Trends Student-centric teaching models Consumer-centric/ personalized health care New illnesses and new treatments Information overload Early intervention/prevention Continuous online education for MDs/others Decision support tool training Prediction of illness - Genomics

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16 Future Directions Mobility many approaches cell phones, disease management, wireless Store and Forward processes

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18 Methodology for Store and Forward Telepsychiatry To test a process whereby a minute video clip of a structured psychiatric interview is sent to a distant consultant with a short relevant clinical history. Diagnostic conclusions will be compared between English Diagnostic conclusions will be compared between English and Spanish speaking psychiatrists, and across these groups following professional translation of the structured interviews.

19 Equipment

20 Clinical Interview

21 Structured Questionnaire

22 Consultant Opinion

23 Summary Traditional i telemedicine i by videoconferencing i is proven, and is in increasingly widespread use in identified high needs environments, using a variety of clinical models. Studies are starting to investigate the integration of multiple technologies to provide online care more consumer/home focused and useful for chronic disease monitoring. How can we integrate these into the traditional health system? Increasingly mobile environments, and store and forward systems offer tremendous opportunities. There is a massive training and change management challenge. Are we at a tipping point..

24 Thank you Peter Yellowlees, M.D. Professor of Psychiatry UC Davis Medical Center